Which factors are associated with attitudes of midwives toward full scope of practice?

Objective: Approximately 50% of registered midwives practice full scope of practice in Ontario, Canada, as they are regulated to do so by the College of Midwives of Ontario (CMO). Full scope of practice is defined as the practice of midwifery as outlined by the CMO and includes management of childbirth complicated by oxytocin induction and/or augmentation and epidural analgesia. Scope of practice restrictions have been attributed to midwifery attitudes toward full scope of practice. This study aims to identify factors that predict favourable attitudes of Ontario midwives toward full scope of practice.

Methods: The survey included four sections with yes/no, multiple choice and Likert scale response options measuring concepts including attitudes toward full scope of practice. Statistical evaluation was descriptive and explorative. Possible factors associated with favourable attitudes of Ontario midwives toward full scope of practice were assessed using multiple logistic regression models.

Results: Of the 174 respondents, 170 were considered for analysis. Results show that midwives who work full time in midwifery practice groups (OR: 3.73, 95% CI 1.49 – 9.29, p = 0.005) as well as midwives who work full scope of practice (OR: 3.62, 95% CI 1.25 – 10.44, p = 0.02) are more likely to have favourable attitudes toward full scope of practice compared to those who worked part time or without full scope of practice. Age, work experience, number of midwives, rural status and previous full scope of practice provided inconclusive results.

Conclusion: Supporting midwives to work to their full scope of practice may influence the attitudes of midwives toward full scope of practice which could affect the regulation of scope of practice across the province for Ontario midwives. Current models of midwifery service provision should be assessed for the potential impact on the attitudes of midwives toward full scope of practice.